Friday, October 10, 2008

When the penny drops


It was good to spend two days with other midwives this week, in a conference on 'emerging issues in pregnancy, birth and postnatal care' at the new Women's hospital There were many interesting presentations by midwives who are involved in research on topics including estimating the volume of blood loss at a particular time; urinary incontinence experienced by women who are pregnant with their first child; an audit of treatment of newborn babies with antibiotics; expressing breast milk; and 'New look' postnatal care in Barwon Health, where well women with healthy babies are 'cared for' in a way that is radically different from standard medically based postnatal care.

An outstanding presentation, in my opinion, was given by several midwives who are providing one-to-one primary care through the Cosmos Trial. These midwives told about the changes they have experienced since managing their own caseloads. They expressed pride, and satisfaction, and told of the positive responses of women who are enlisted in the trial, and who have been allocated to receive the 'intervention' - a known midwife.

It is interesting to note that a new Cochrane Review of Midwife-led versus other models of care for childbearing women has been released. This review recommends that "all women should be offered midwife-led models of care" - that is, primary maternity care by a known midwife who is committed to attending that woman as the responsible professional in pregnancy, labour and birth, and through the postnatal care. This is what the caseload midwives at the Women's, and at Sunshine, Geelong, and other places are offering. It's also what independent midwives do.

It is quite thrilling to me to see this 'evidence based' model of midwifery care being implemented and researched in the major, mainstream maternity services. The midwives who have stepped out of their previous shift work, hospital nurse mode, and embraced the full midwife identity are excited about what they are doing. That's what I mean by 'when the penny drops'. Midwifery becomes so much more meaningful. We ARE 'with woman'. It's real.

Some readers of this blog may remember how, several years ago, there was strong consumer outcry objecting to the closure of the Family Birth Centre at the Women's. Many women have used Birth Centres over the past 30 years. My fourth child, Josh, was born at the Women's Birth Centre.

The hospital is seeking now to enable normal birthing for any woman in its care; that the focus be on the woman rather than the facility. Having heard the presentations by the caseload midwives, I believe this is now beginning to happen.

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